Celiac Disease in Children: What Has Changed?

The perception of celiac disease (CD) has changed dramatically during the last two decades, with the introduction of new serological tests with high specificity and sensitivity. CD prevalence in recent years is increasing as it is for other autoimmune diseases. Due to the high prevalence of CD, it is one of the most important diseases of the digestive tract. The clinical manifestations of CD have changed significantly in the last two decades, and these are much more diverse than reported previously. The new European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria for CD indicate that biopsy can be avoided in strictly selected groups of pediatric patients. The first experiences with these new criteria are positive. A meta-analysis evaluating the relationship between early nutrition and the risk of CD recommends that both early (< 4 months) and late (> 7 months) introduction of gluten to the diet should be avoided, and that gluten should be introduced while the infant is still breastfeeding. The prevalence rates of CD between two cohorts with different infant feeding practice were significantly different, and the prevalence of CD in 12-year-old children were significantly reduced, suggesting that prevention of CD is possible.